Organizing Nursing Knowledge And Practice Into Care Delivery Models That Catalyze Quality

Abstract

Nurses represent the largest single component of hospital staffing, typically as a ratio to hospitalized patients. Observational studies have correlated higher nurse-patient ratios with better patient quality outcomes, yet the evidence has been summarized as too weak for policy or practice recommendations. Furthermore, examining nursing as a static entity doesn't provide necessary knowledge about ‘how’ nursing functions to influence quality, or how it can potentially be improved. Clinical Nurse Leader (CNL) integrated care delivery is an emerging nursing model with growing adoption in diverse health systems. A recent study empirically validated a CNL Practice Model that conceptualizes the care delivery’s Readiness, Structuring, Practice, Outcome, and Value domains. This study empirically characterized CNL-integrated care delivery mechanisms of action through analysis of the concrete operationalization of CNL Practice Model domains, using case study design. The case was a health system comprising four hospitals and a clinic network. The findings suggest nursing practice organized to focus on microsystem care processes catalyzes multidisciplinary engagement with, and consistent enactment of, best practices, through the ongoing activities of communication, relationship and team building, and engagement support. This occurs via a structured workflow that at first appears simply “wrong,” for example not having a patient assignment, but over time results in the care team knowing “what works in the clinical flow so quality is happening at the same time as practice.” The findings indicate the analytic generalizability of the model’s conceptual domains/pathways, and show how nursing can serve as an organizational strategy for continuous quality and improvement.